Search Results (1,610)

Background: Traumatic brain injury (TBI) is referred to as a “silent epidemic” due to its limited awareness in the general public. Nevertheless, it can cause chronic, lifelong physical and cognitive impairments with severe impact on quality of life, resulting in high healthcare costs and loss of employment. To evaluate the outcome after mild and moderate TBI, “return to work (RTW)” is a relevant parameter, reflecting the socio-economic consequences of TBI. Our study aims to summarize RTW-rates to raise awareness on the impact of non-severe TBI. Methods: We performed a systematic literature review screening the databases Medline, Embase and Web of Science for studies reporting RTW in mild to moderate TBI. Studies that reported on RTW after mild or moderate TBI (defined by GCS > 9) in adults, with a minimum follow-up of six months were included. Risk of bias was assessed using the QUIPS tool. Results: We included 13 studies with a total 22,550 patients. The overall RTW rate after at least six months, varies between 37% and 98%. Full RTW is reported in six of the included 13 studies and varies between 12% and 67%. In six studies (46%) the RTW-rate by the end of follow-up was ≤60%, with four studies being from high-income countries. Conclusion: Mild and moderate TBI have a high impact on employment rates with diverging rates for RTW even between high-income countries. Increasing the societal awareness of this silent epidemic is of utmost importance and is one of the missions of the Swiss Brain Health Plan. Full article

Eye-movement assessment is a key component of neurological evaluation, offering valuable insights into neural deficits and underlying mechanisms. This narrative review explores the emerging subject of digital eye-movement outcomes (DEMOs) and their potential as sensitive biomarkers for neurological impairment. Eye tracking has become a useful method for investigating visual system functioning, attentional processes, and cognitive mechanisms. Abnormalities in eye movements, such as altered saccadic patterns or impaired smooth pursuit, can act as important diagnostic indicators for various neurological conditions. The non-invasive nature, cost-effectiveness, and ease of implementation of modern eye-tracking systems makes it particularly attractive in both clinical and research settings. Advanced digital eye-tracking technologies and analytical methods enable precise quantification of eye-movement parameters, complementing subjective clinical evaluations with objective data. This review examines how DEMOs could contribute to the localisation and diagnosis of neural impairments, potentially serving as useful biomarkers. By comprehensively exploring the role of eye-movement assessment, this review aims to highlight the common eye-movement deficits seen in neurological injury and disease by using the examples of mild traumatic brain injury and Parkinson’s Disease. This review also aims to enhance the understanding of the potential use of DEMOs in diagnosis, monitoring, and management of neurological disorders, ultimately improving patient care and deepening our understanding of complex neurological processes. Furthermore, we consider the broader implications of this technology in unravelling the complexities of visual processing, attention mechanisms, and cognitive functions. This review summarises how DEMOs could reshape our understanding of brain health and allow for more targeted and effective neurological interventions. Full article

Traumatic brain injury (TBI) represents a multifaceted pathological condition resulting from external forces that disrupt neuronal integrity and function. This narrative review explores the intricate relationship between dietary macronutrients, gut microbiota (GM), and neuroinflammation in the TBI. We delineate the dual aspects of TBI: the immediate mechanical damage (primary injury) and the subsequent biological processes (secondary injury) that exacerbate neuronal damage. Dysregulation of the gut–brain axis emerges as a critical factor in the neuroinflammatory response, emphasizing the role of the GM in mediating immune responses. Recent evidence indicates that specific macronutrients, including lipids, proteins, and probiotics, can influence microbiota composition and in turn modulate neuroinflammation. Moreover, specialized dietary interventions may promote resilience against secondary insults and support neurological recovery post-TBI. This review aims to synthesize the current preclinical and clinical evidence on the potential of dietary strategies in mitigating neuroinflammatory pathways, suggesting that targeted nutrition and gut health optimization could serve as promising therapeutic modalities in TBI management. Full article

Background and Objectives: Collision-sport athletes, such as rugby players, are at risk of sport-related concussion (SRC). Women are known to be at higher risk of SRC and may experience more severe and chronic symptomology than men. Knowledge of the factors that affect a player’s disclosure of their concussive symptoms could help to inform strategies to improve compliance with reporting and management of head injuries. The aim of this study was to investigate the factors that may impact women rugby players’ disclosure of a concussion. Methods: Twenty-eight adult (≥18 years of age) elite and semi-elite women rugby players from the UK and Ireland (n = 17) and the United States (n = 11) were interviewed on their playing background and SRC experience in women’s rugby via one-on-one interviews (UK and Ireland) or an online questionnaire (US). Results: SRC data were analysed inductively using a thematic analysis approach to determine the potential reasons for SRC non-disclosure in women’s rugby. Four main themes were identified which may influence a player’s SRC non-disclosure: 1. women rugby players are self-managing SRC; 2. work-related concerns impact on SRC disclosure; 3. players and support staff lack knowledge on SRC management; and 4. poor internal and external communication affect the support players receive when injured. Conclusions: The findings were consistent across players from different countries. This research highlighted several factors that may impact on women rugby players’ disclosure of SRC regardless of country of origin (UK, Ireland, or US) and access to concussion care. Coaches and management teams should be aware of these reasons, which may enhance how they discuss and manage concussion. There is a clear need for further education on concussion for players and support staff and for strategies to create environments where women can openly discuss their concussion concerns. Full article

The accurate, repeatable, and cost-effective quantitative characterization of mild traumatic brain injuries (mTBIs) is crucial for safeguarding the long-term health and performance of high-risk groups, including athletes, emergency responders, and military personnel. However, gaps remain in optimizing mTBI assessment methods, especially regarding the integration of neuromechanical metrics such as reaction time (RT) in predictive models. Background/Objectives: This review synthesizes existing research on the use of neuromechanical probabilistic models as tools for assessing mTBI, with an emphasis on RT’s role in predictive diagnostics. Methods: We examined 57 published studies on recent sensing technologies such as advanced electromyographic (EMG) systems that contribute data for probabilistic neural imaging, and we also consider measurement models for real-time RT tracking as a diagnostic measure. Results: The analysis identifies three primary contributions: (1) a comprehensive survey of probabilistic approaches for mTBI characterization based on RT, (2) a technical examination of these probabilistic algorithms in terms of reliability and clinical utility, and (3) a detailed outline of experimental requirements for using RT-based metrics in psychomotor tasks to advance mTBI diagnostics. Conclusions: This review provides insights into implementing RT-based neuromechanical metrics within experimental frameworks for mTBI diagnosis, suggesting that such metrics may enhance the sensitivity and utility of assessment and rehabilitation protocols. Further validation studies are recommended to refine RT-based probabilistic models for mTBI applications. Full article

Traumatic brain injury (TBI) causes multiple cerebrovascular disruptions and oxidative stress. These pathological mechanisms are often accompanied by serious impairment of cerebral blood flow autoregulation and neuronal and glial degeneration. Background/Objectives: Multiple biochemical cascades are triggered by brain damage, resulting in reactive oxygen species production alongside blood loss and hypoxia. However, most currently available early antioxidant therapies lack capacity and hence sufficient efficacy against TBI. The aim of this study was to test a novel catalytic antioxidant nanoparticle to alleviate the damage occurring in blast TBI. Methods: TBI was elicited in an open blast rat model, in which the rats were exposed to the effects of an explosive blast. Key events of the post-traumatic chain in the brain parenchyma were studied using immunohistochemistry. The application of a newly developed biologically compatible catalytic superoxide dismutase mimetic carbon-based nanocluster, a poly-ethylene-glycol-functionalized hydrophilic carbon cluster (PEG-HCC), was tested post-blast to modulate the components of the TBI process. Results: The PEG-HCC was shown to significantly ameliorate neuronal loss in the brain cortex, the dentate gyrus, and hippocampus when administered shortly after the blast. There was also a significant increase in endothelial activity to repair blood–brain barrier damage as well as the modulation of microglial and astrocyte activity and an increase in inducible NO synthase in the cortex. Conclusions: We have demonstrated qualitatively and quantitatively that the previously demonstrated antioxidant properties of PEG-HCCs have a neuroprotective effect after traumatic brain injury following an explosive blast, acting at multiple levels of the pathological chain of events elicited by TBI. Full article

Background: Despite improvements in technology and safety measures, injuries from collisions involving motor vehicles (CIMVs) continue to be prevalent. Therefore, our goal is to investigate the different patterns of head injuries associated with CIMVs. Method: This is a single-center, retrospective study of patients with motor vehicle-related trauma between 1 January 2016–31 December 2023. Patients were identified based on the International Classification of Diseases (ICD) injury codes and the Abbreviated Injury Severity (AIS) for body region involvement. Result: 536 patients met the inclusion criteria. The majority of the injured population includes pedestrians (46.8%), followed by motorcycle drivers (25.2%), bicyclists (18.7%), and motor vehicle drivers (9.3%). The male-to-female ratios for bicyclists and motorcyclists were 13.7:1 and 11.9:1, respectively, which is higher compared with motor vehicle occupants and pedestrians, with ratios of 2.3:1 and 1.5:1. Patients with blunt trauma (99.63%) were higher than penetrating trauma (0.37%). In most cases, the head had the highest AIS score, with a mean of 3.7. Additionally, the median Injury Severity Score (ISS) was 20. Skull fractures were the most prevalent, followed by hemorrhages, lacerations, contusions, and abrasions. Conclusions: The most prevalent injuries were head injuries and fractures. Fractures were the most common, followed by hemorrhage, laceration, contusion, and abrasion. These findings underscore the high incidence of TBI and fractures in such CIMVs, highlighting the need for targeted trauma interventions and the need for injury prevention strategies to mitigate these severe outcomes. Full article

Traumatic brain injury (TBI) during snowboarding sports is a major concern. A robust evaluation of existing snowboarding helmets is desired. Head kinematics (i.e., linear acceleration, angular velocity, angular acceleration) and associated brain responses (brain pressure, equivalent (von Mises) stress, and maximum principal strain) of the head are a predominant cause of TBI or concussion. The conventional snowboarding helmet, which mitigates linear acceleration, is typically used in snow sports. However, the role of conventional snowboarding helmets in mitigating angular head kinematics is marginal or insignificant. In recent years, new anti-rotational technologies (e.g., MIPS, WaveCel) have been developed that seek to reduce angular kinematics (i.e., angular velocity, angular acceleration). However, investigations regarding the performance of snowboarding helmets in terms of the mitigation of head kinematics and brain responses are either extremely limited or not available. Toward this end, we have evaluated the performance of snowboarding helmets (conventional and anti-rotational technologies) against blunt impact. We also evaluated the performance of newly developed low-cost, silica-based anti-rotational pads by integrating them with conventional helmets. Helmets were mounted on a head surrogate–Hybrid III neck assembly. The head surrogate consisted of skin, skull, dura mater, and brain. The geometry of the head surrogate was based on the GHBMC head model. Substructures of the head surrogate was manufactured using additive manufacturing and/or molding. A linear impactor system was used to simulate/recreate snowfield hazards (e.g., tree stump, rock, pole) loading. Following the ASTM F2040 standard, an impact velocity of 4.6 ± 0.2 m/s was used. The head kinematics (i.e., linear acceleration, angular velocity, angular acceleration) and brain simulant pressures were measured in the head surrogate. Further, using the concurrent simulation, the brain simulant responses (i.e., pressure, von Mises stress, and maximum principal strain) were computed. The front and side orientations were considered. Our results showed that the helmets with anti-rotation technologies (i.e., MIPS, WaveCel) significantly reduced the angular kinematics and brain responses compared to the conventional helmet. Further, the performance of the silica pad-based anti-rotational helmet was comparable to the existing anti-rotational helmets. Lastly, the effect of a comfort liner on head kinematics was also investigated. The comfort liner further improved the performance of anti-rotational helmets. Overall, these results provide important data and novel insights regarding the performance of various snowboarding helmets. These data have utility in the design and development of futuristic snowboarding helmets and safety protocols. Full article

Background: Lactate is a byproduct of glycolysis, often linked to oxygen deprivation. This study aimed to examine how lactate levels (LLs) affect clinical outcomes in patients with severe TBI, hypothesizing that higher LLs would correlate with worse outcomes. Methods: This is a level 1 single-center, retrospective study of patients with severe TBI between 1 January 2020 and 31 December 2023, inclusive. Results: Single-factor ANOVA indicated a significant decrease in LLs with increasing age. Linear regression models showed the same for hospital admission, Intensive Care Unit (ICU) admission LLs, and death LLs. Prognostic scores such as Injury Severity Scores (ISS) and Glasgow Coma Score (GCS) showed a strong correlation with both Hospital admission and ICU admission LLs. ANOVA indicated higher LLs with increasing ISS and increasing LLs with decreasing GCS. Linear regressions revealed a strong positive correlation between ISS and LLs. On linear regression, the LL measured at hospital admission and ICU admission was positively associated with the length of stay (LOS) in the hospital, LOS in the ICU, ventilator days, and mortality. Linear regression models showed that a decreased delta LL during ICU admission led to an increased LOS at the hospital and the ICU, as well as a higher number of days on a ventilator. Discussion: We discovered that high LLs were linked to higher AIS and GCS scores, longer stays in the hospital and ICU, more days requiring a ventilator, and higher mortality rates in patients with severe TBI. Conclusions: LLs can be considered a strong predictor of poor clinical outcomes in patients with severe TBI. Full article

Traumatic direct type carotid cavernous fistula (CCF) is an acquired arteriovenous shunt between the carotid artery and the cavernous sinus post severe craniofacial trauma or iatrogenic injury. We reported a 46-year-old woman who had developed a traumatic direct type CCF after severe head trauma with a skull base fracture and brain contusion hemorrhage. The clinical manifestations of the patient included pulsatile exophthalmos, proptosis, bruits, chemosis, and a decline in consciousness. Magnetic resonance imaging (MRI) revealed engorgement of the right superior ophthalmic vein (SOV), perifocal cerebral edema in the right frontal–temporal cortex, right basal ganglia, and brain stem. Digital subtraction angiography (DSA) disclosed a direct type high-flow CCF with an aggressive cortical venous reflux drainage pattern, which was attributed to Barrow type A and Thomas classification type 5. After partial treatment by transvenous coil embolization for the CCF, the residual high-flow fistula with aggressive venous drainage had an unusual rapid spontaneous resolution in a brief period. Therefore, it is strongly recommended to meticulously monitor the clinical conditions of patients and perform brain MRI and DSA at short intervals to determine the treatment strategy for residual CCF after partial endovascular treatment. Full article

We describe two patients with a recent stroke or traumatic brain injury associated with aphasia and cognitive impairment who required detention (under the Mental Health Act) as well as some form of restraint during their inpatient rehabilitation. Each of these episodes of care occurred early into the COVID-19 pandemic and we speculate that the detention (and restraint) was attributable, at least in part, to the difficulty in comprehending COVID-19-related changes in patterns of staff interaction and the mandated social and visiting restrictions. We reflect on the impact of these restrictions on the need for detention and how these factors could have been mitigated through speech and language therapist (SLT) and broader multidisciplinary team (MDT) intervention. Full article

Traumatic brain injury (TBI) is a leading cause of disability and mortality globally, stemming from both primary mechanical injuries and subsequent secondary responses. Effective early management of moderate-to-severe TBI is essential to prevent secondary damage and improve patient outcomes. This review provides a comprehensive guide for the resuscitation and stabilization of TBI patients, combining clinical experience with current evidence-based guidelines. Key areas addressed in this study include the identification and classification of severe TBI, intubation strategies, and optimized resuscitation targets to maintain cerebral perfusion. The management of coagulopathy and special considerations for patients with concomitant hemorrhagic shock are discussed in depth, along with recommendations for neurosurgical interventions. This article further explores the role of multimodal neuromonitoring and targeted temperature management to mitigate secondary brain injury. Finally, it discusses end-of-life care in cases of devastating brain injury (DBI). This practical review integrates foundational and recent advances in TBI management to aid in reducing secondary injuries and enhancing long-term recovery, presenting a multidisciplinary approach to support acute care decisions in TBI patients. Full article

Background/Objectives: Traumatic brain injury (TBI) can lead to substantial disability and health loss. Despite its importance and impact worldwide, no treatment options are currently available to help protect or preserve brain structure and function following injury. In this review, we discuss the potential benefits of using omega-3 polyunsaturated fatty acids (O3 PUFAs) as therapeutic agents in the context of TBI in the paediatric and adult populations. Methods: Preclinical and clinical research reports investigating the effects of O3 PUFA-based interventions on the consequences of TBI were retrieved and reviewed, and the evidence presented and discussed. Results: A range of animal models of TBI, types of injury, and O3 PUFA dosing regimens and administration protocols have been used in different strategies to investigate the effects of O3 PUFAs in TBI. Most evidence comes from preclinical studies, with limited clinical data available thus far. Overall, research indicates that high O3 PUFA levels help lessen the harmful effects of TBI by reducing tissue damage and cell loss, decreasing associated neuroinflammation and the immune response, which in turn moderates the severity of the associated neurological dysfunction. Conclusions: Data from the studies reviewed here indicate that O3 PUFAs could substantially alleviate the impact of traumatic injuries in the central nervous system, protect structure and help restore function in both the immature and adult brains. Full article

Tissue engineering research for neurological applications has demonstrated that biomaterial-based structural bridges present a promising approach for promoting regeneration. This is particularly relevant for penetrating traumatic brain injuries, where the clinical prognosis is typically poor, with no available regeneration-enhancing therapies. Specifically, repurposing clinically approved biomaterials offers many advantages (reduced approval time and achieving commercial scaleup for clinical applications), highlighting the need for detailed screening of potential neuromaterials. A major challenge in experimental testing is the limited availability of neuromimetic, technically accessible, cost-effective, and humane models of neurological injury for efficient biomaterial testing in injury-simulated environments. Three dimensional (3D) organotypic brain slices bridge the gap between live animal models and simplified co-cultures and are a versatile tool for studies on neural development, neurodegenerative disease and in drug testing. Despite this, their utility for investigation of neural cell responses to biomaterial implantation is poorly investigated. We demonstrate that murine brain organotypic slices can be used to develop a model of penetrating traumatic brain injury, wherein a surgical-grade biomaterial scaffold can be implanted into the lesion cavity. Critically, the model allowed for examination of key cellular responses involved in CNS injury pathology/biomaterial handling: astrogliosis, microglial activation and axonal sprouting. The approach offers a technically simple and versatile methodology to study biomaterial interventions as a regenerative therapy for neurological injuries. Full article

Background/Objectives: The aim of this study was to determine if performing ultrasound-guided, bilateral, two-level cervical sympathetic chain blocks (2LCSBs) (performed on subsequent days) improves symptoms associated with traumatic brain injury (TBI) that do not overlap with posttraumatic stress disorder (PTSD). Methods: A retrospective chart review was conducted between August 2022 and February 2023. We identified twenty patients who received bilateral 2LCSBs for PTSD and anxiety symptoms and who also had a history of TBI. Neurobehavioral Symptom Inventory (NSI) scores were collected at baseline, one week, and one month post treatment in 13 males and 7 females. A sub-analysis of the first ten questions of the NSI, which we identified as not overlapping with PTSD or anxiety symptoms, generated an NSI sub-score. Results: Out of 20 patients, all showed improvement in their NSI scores and NSI sub-scores. The NSI sub-scores had a baseline average of 15.45 (on a 40-point scale); the average score at one week post treatment was 8.30; and that at one month post treatment was 7.80. This represents a 49.51% improvement in TBI symptoms which did not overlap with PTSD or anxiety symptoms between baseline and one month. Conclusions: The use of bilateral 2LCSBs may be helpful in treating patients with TBI, regardless of the presence of comorbid PTSD symptoms. Full article